Objective Treatment delays and suboptimal adherence to posttreatment surveillance may adversely affect head and neck cancer (HNC) outcomes. Such challenges can be exacerbated in safety-net settings that struggle with limited resources and serve a disproportionate number of patients vulnerable to gaps in care. This study aims to characterize treatment delays and adherence with posttreatment surveillance in HNC care at an urban tertiary care public hospital in San Francisco. Study Design Retrospective chart review. Setting Urban tertiary care public hospital in San Francisco. Subjects and Methods We identified all cases of HNC diagnosed from 2008 to 2010 through the electronic medical record. We abstracted data, including patient characteristics, disease characteristics, pathology and radiology findings, treatment details, posttreatment follow-up, and clinical outcomes. Results We included 64 patients. Median time from diagnosis to treatment initiation (DTI) was 57 days for all patients, 54 days for patients undergoing surgery only, 49 days for patients undergoing surgery followed by adjuvant radiation ± chemotherapy, 65 days for patients undergoing definitive radiation ± chemotherapy, and 29 days for patients undergoing neoadjuvant chemotherapy followed by radiation or chemoradiation. Overall, 69% of patients completed recommended treatment. Forty-two of 61 (69%) patients demonstrated adherence to posttreatment visits in year 1; this fell to 14 out of 30 patients (47%) by year 5. Conclusion DTI was persistently prolonged in this study compared with prior studies in other public hospital settings. Adherence to posttreatment surveillance was suboptimal and continued to decline as the surveillance period progressed.

Objective Describe current practices and challenges in personal protective equipment (PPE) use among US otolaryngologists during the COVID-19 pandemic. Study design Online survey. Setting Academic and non-academic healthcare institutions. Subjects and methods Subjects included US otolaryngology physicians. Emails were sent on April 17, 2020 to program coordinators at 121 residency programs, who were requested to forward the email to program directors for distribution. Further recruitment occurred through snowball recruitment. The survey was closed on June 15, 2020. Results Sixty-one participants completed the survey. 95.1% reported routine access to full PPE (N95 ± powered air purifying respirator [PAPR], gown, gloves, eye protection) for aerosol-generating procedures (AGPs) in COVID-19 patients, while 68.9% had routine access to full PPE for AGPs in patients without confirmed COVID-19. 88.5% had routine access to full PPE for potential aerosol-generating procedures (pAGPs) in COVID patients, while 80.3% had routine access to full PPE for pAGPs in patients without confirmed COVID. All participants felt that they “always” or “usually” had necessary PPE to safely perform procedures and surgeries on COVID patients. 83.6% received N95 fitting in the past year, and 93.4% reported adequate PPE training. Conclusion The majority of participants reported routine access to full PPE for AGPs and pAGPs in all patients, regardless of COVID status. There was a high perception of security, as well as adequate N95 fitting and PPE training. Areas for improvement include: optimizing PPE availability for AGPs in patients without confirmed COVID and wider recognition of otolaryngologic procedures as high risk for aerosolization.

ObjectiveThis scoping review aims to explore the current body of literature to characterize how short‐term surgical trips (STSTs) in Otolaryngology‐Head and Neck Surgery (OtoHNS) contribute to surgical, educational, and sustainability‐based outcomes in low‐ and middle‐income countries (LMICs). We aim to use these data to synthesize aspects of STSTs that are successful with the hopes of shaping future global efforts.Data SourcesData sources included Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus.Review MethodsA comprehensive search was conducted on several databases from inception to October 14, 2021. We included primary studies exploring any surgical or educational outcomes of global short‐term surgical endeavors within LMICs. Data were then extracted to evaluate the heterogenous body of literature that exists, characterizing the surgical, educational, and sustainability‐based outcomes.ResultsForty‐Seven studies were included in the final analysis. Most publications were focused on surgical interventions (39 of 47; 82.9%); 13 (27.7%) studies included education as the primary aim and 12 (25.5%) considered sustainability a significant aim. Of the 94 first and last authors, there were zero first authors and only one last author with an LMIC affiliation. Twenty‐six studies (55%) mentioned that any patients were seen in follow‐up, ranging from one day to five years.ConclusionOur scoping review demonstrates that most STSTs have focused primarily on surgical procedures with a lack of appropriate long‐term follow‐up. However, the available outcome‐based information presented helps identify factors that characterize a strong short‐term global surgical program.Level of EvidenceN/A Laryngoscope, 2023

Purpose/Objective(s): Due to a risk of 18% to 45% of occult metastases among the clinically free of nodes head and neck squamous cell carcinoma (HNSCC) patients, prophylactic neck irradiation is often mandatory. Based on international guidelines for the selection of the neck node levels, this prophylactic treatment still leads to unnecessary large irradiation of normal tissues because bilateral drainage is the rule in only 30% to 50% of individuals, and 15% to 30% of the tumors drain in unpredicted nodal basins. Sentinel lymph node (SLN) single-photon emission computerized tomography (SPECT/CT) lymphoscintigraphy makes it possible to individually predict cervical subregions requiring prophylactic irradiation in cN0 patients. This ongoing prospective phase 2 study analyzes its oncological safety. Materials/Methods: Twenty-one patients with newly diagnosed cN0 SCC of the oral cavity, oropharynx, larynx, or hypopharynx were included. All patients were imaged with SPECT/CT after 99mTc nanocolloid injection around the tumor. The neck levels containing up to 4 hottest nodes were identified and selected for prophylactic irradiation (CTVn-LS) by volumetric modulated arc therapy. A comparative virtual planning was performed with volumes selected according to international guidelines (CTVn-IG). Results: Migration was observed in all of the 21 patients (1 with gamma probe only) with an average of 2.7 sentinel nodes detected per patient. CTVn-LS was totally encompassed by CTVn-IG in all patients but 2 with an unpredicted drainage in retropharyngeal levels. On average, CTVn-LS and related planning target volume (PTV) were 2 times smaller than IG ones. This led to significant dose decrease in identified organs at risk as well as remaining volume at risk. With a median follow-up of 14 months, no regional relapse was observed, while 2 patients had a local one (9%). Currently, 3 patients have died (1 patient from geriatric degradation and 2 experienced fatal local relapse). Conclusion: SPECT/CT lymphoscintigraphy of SLN allows individualization of prophylactic node CTV in cN0 HNSCC patients eligible for definitive radiation therapy. Both CTV and PTV are significantly reduced, which results in a significant dose decrease in all identified organs at risk. At a median follow-up of 14 months, no regional relapse was observed, but further follow-up and recruitment are necessary to ensure the oncological safety.

Objectives: Describe the current state of otolaryngologic residency training with recent changes to the program requirements by the Accreditation Council for Graduate Medical Education (ACGME) which increased the amount of time on intern year otolaryngology rotations from 3 to 6 months. Methods: A cross-sectional study was performed and recruitment was done via personalized email sent to program coordinators of 113 ACGME-accredited otolaryngology training programs within the Unites States. The message requested a breakdown of the amount of time and specialty in which first year otolaryngologic residents rotated. Interval follow ups were sent at 3 and 6 months for coordinators who had not responded. Results: Response rate was 79.7% (90/113). General surgery and surgical intensive care unit were the two most common non-otolaryngologic rotations (92.2% and 96.6% respectively) while ophthalmology and radiation oncology were the least common at 7.8% each. All first year residents spend time on an inpatient otolaryngologic rotation, while 30.7% spend time on outpatient rotations. The most common subspecialties were head and neck oncology (40.0%) followed by pediatric otolaryngology (36.0%). Conclusions: Otolaryngologic training continues to become more slanted towards specialty-specific training and a concurrent reduction in “off-service” rotations. General inpatient services still predominate the intern year both inter- and intra-departmentally. These data provide insight into the training environment of the otolaryngologic trainees set to graduate residency for the first time this year.